Employer-Based Approach to Increase Support for and Provision of LA/PMs in India Reproductive Health Supplies Coalition Meeting New Delhi, India October 10–11, 2013 Presenter: Holly Connor, EngenderHealth Jane Wickstrom, EngenderHealth Cindi R. Cisek, Meridian Group International, Inc. Reach Men at the Workplace to Promote FP and LA/PMs Family planning initiative in Kanpur, Uttar Pradesh: – Builds on best practices for company-based health care initiatives – Tests model focusing on increasing sustained access to and use of FP, especially LA/PMs – IUCD, female sterilization, and vasectomy Company’s Active Participation and Inputs Required Recruited small and medium- sized businesses from various sectors in Kanpur, Uttar Pradesh Company inputs – Providing venue and allowing participation during working hours – Covering time off for employees – Designating a peer health coordinator – Placing posters for the program in highly visible locations Key Inputs from Both the Company and RESPOND 1. Health talks by RESPOND 2. Health desks: One-on-one information sessions with peers 3. Print materials: LA/PM posters and leaflets 4. Health coordinator training 5. Clinic facility referrals within geographic catchment areas of each business LA/PM Print Materials Participating Companies Employees Company Name Men Women Type of Company A2Z Group 1,200 0 Waste management Ashok Griha Udyog Kendra Ltd. 300 50 Spices and pickles Asian Exports Private Ltd. 108 22 Leather saddles and riding gear Equiplus India Exports Ltd. 720 80 Leather saddles and riding gear Goldee Masale 650 350 Spices and pickles Indicoat Shoe Accessories 500 250 Shoe manufacturing Jyoti Capsules Private Ltd. 75 80 Soft generic capsules Kapoor Polyprint Private Ltd. 200 0 Laminate pouches Kehr Surgical Private Ltd. 144 6 Surgical blades Nerolac Private Limited 700 0 Paint Pepsico Indico Holding Private Limited 1,200 0 Beverage and bottling facility RGP Moulds Private Ltd. 150 0 Plastic molds Total 5,947 838 6,785 Impressive Results Reached 3,562 employees with small-group or one-on-one discussions during work hours. Recruited and trained 18 company health coordinators in LA/PMs. LA/PM acceptor rate ~1.3% of total workforce. Some businesses’ acceptor rates were 3-4% of their workers and wives accepting an LA/PM. Endline Evaluation In May and June 2012, RESPOND surveyed 1,543 employees at six companies through a convenience sample. Study objectives were to identify: – What percentage of employees were exposed to RESPOND’s intervention? – What percentage of employees (or their spouses) adopted a method of FP or switched to a new method within the last year? – Would nonusers consider using FP in the future? If so, would they consider an LA/PM? Profile of Employees ■ The sample for the endline survey consisted primarily of men (96.4%). ■ 72.2% of participants were married. ‒ 97.7% of married participants had children. ■ 43.4% of married participants were already using FP at the beginning of the intervention. Findings: Exposure to the Intervention Exposure to the intervention was high: – 97.7% of respondents reported that they had seen at least one of the posters or brochures in their workplace. – 79.3% attended a health talk; 42.8% attended a health desk; 39.2% participated in both. A2Z Ashok Equiplus Kapoor Kehr PepsiCo TOTAL Health talk 81.3% 100.0% 100.0% 86.9% 24.6% 63.0% 79.3% Health desk 75.3% 57.3% 30.8% 53.6% 49.2% 12.6% 42.8% Both 70.4% 57.3% 30.8% 50.0% 6.2% 12.2% 39.2% Neither 13.8% 0.0% 0.0% 9.5% 32.3% 36.6% 17.2% Improved Couple Communication for FP FP discussion was higher among those exposed to the intervention than among those who were not: ‒ 84.2% of those who participated in either health talks or health desks reported discussing FP with their spouse in the last year. ‒ 51% of those who did not participate in the intervention reported discussing FP with their spouse in the last year. Goal to Support LA/PM Use Achieved: Method Switching Many of the exposed who switched selected an LA/PM. Among pill users who switched, for example, 22% chose an IUD, 41% chose tubectomy, and 14% chose vasectomy. Method Switching among Health Talk or Health Desk Participants (n = 144) Method adopted Male Do not Method condom Pill Injectables IUD Tubectomy Vasectomy know used before Male condom 0.0% 20.7% 8.6% 25.9% 25.9% 19.0% 0.0% (n = 58) Pill 17.5% 0.0% 4.8% 22.2% 41.3% 14.3% 0.0% (n = 63) Injectables 0.0% 0.0% 0.0% 33.3% 44.4% 11.1% 11.1% (n = 9) IUD (n = 14) 7.1% 7.1% 7.1% 0.0% 42.9% 35.7% 0.0% Nonusers of FP Adopt and Intend to Adopt Methods 12.5% of married nonusers exposed to intervention adopted FP. The male condom was the method most frequently adopted (41.5%), followed by the IUD (27.7%). 94.7% of participants reported intending to adopt FP in the future: – Tubectomy (58%), the IUD (40.1%), and vasectomy (31.3%) were most often listed. Fewer (60.4%) of those who did not participate in the intervention said that they would consider using FP in the future. User Testimonials “I have a daughter aged 7 years…It “I had never used a family planning method was through one of the health talks, before. I attended several health talks at the held at my factory, that I came to factory. With 3 children, my wife and I knew know about the IUD as a safe, we didn’t want anymore. Although I had simple, and effective method of FP, many concerns, it really helped me to talk and I got it inserted within two days of with the health coordinator who had also attending the talk.” had a vasectomy. That was very helpful to me in making my decision. —Reckha, age 30. —Ajeet, age 39 Key Conclusions Reaching men and women at their worksite (with employer endorsement) provides additional credibility to FP messages. Industrial workers’ profile is well-suited for LA/PMs, in that most are married with children—although acceptance rates vary by company. Businesses had varying degrees of commitment to the project—the selection process must identify enthusiastic companies. “Champions” tend to be larger companies with dedicated corporate social responsibility programs—e.g., A2Z and PepsiCo. Company health coordinators are key for a program’s long-term sustainability. www.respond-project.org Photo credits: Slide 1, Staff/EngenderHealth. Slide 2, J. Wickstrom/EngenderHealth. Slide 3, C. Cisek/Meridian Group International (The RESPOND Project). Slide 4, Staff/EngenderHealth (2); M. Joshi/EngenderHealth. Slide 7, C. Cisek/Meridian Group International (The RESPOND Project) (2); S. Rai/ EngenderHealth (2). Slide 11, Staff/EngenderHealth. Slide 14, C. Cisek/Meridian Group International (The RESPOND Project). .